[A] IDENTITY DETAILS 1 ) Name of the applicant 2) Father’s/ Spouse Name 3) Gender MaleFemale Marital status SingleMarried Date of birth 4) Nationality Nationality Status Resident IndividualNon ResidentForeign National 5) Pan Number 6)Unique Identification Number (UID)/ Aadhaar, if any 7) Specify the proof of Identity submitted [B] ADDRESS DETAILS 1) Address for correspondence City/town/village Pin Code State Country 2) Contact Details Tel. (Off.) Tel. (Res.) Mobile Number Fax Number Email id 3) Specify the proof of address submitted for correspondence address 4) Permanent Address (if different from above or overseas address, mandatory for Non-Resident Applicant) City/town/village Pin Code State Country 5) Specify the proof of address submitted for permanent address [C] OTHER DETAILS 1) Gross Annual Income Details (please specify) Income Range per annum Below Rs 1 Lac1-5 Lac5-10 Lac10-25 Lac>25 Lac Or Net-worth as on (date) (Net worth should not be older than 1 year) 2) Occupation (please tick any one and give brief details) Private SectorPublic SectorGovernment ServiceBusinessProfessionalAgriculturistRetiredHousewifeStudentOthers Please Select, if applicable NonePolitically Exposed Person (PEP)Related to a Politically Exposed Person (PEP) Any other information Upload Photo I hereby declare that the details furnished above are true and correct to the best of my knowledge and belief and I undertake to inform you of any changes therein, immediately. In case any of the above information is found to be false or untrue or misleading or misrepresenting, I am aware that I may be held liable for it.